Individual
DOMINIQ ERIC OKODUWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
126 US HIGHWAY 280 W, AMERICUS, GA 31719-8645
(299) 924-6011
Mailing address
922 E JEFFERSON ST, AMERICUS, GA 31709-4780
(299) 310-5892
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
010562
GA
207R00000X
Internal Medicine Physician
Primary
84498
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Enumeration date
03/22/2018
Last updated
06/03/2021
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